Health and social care strategy for older people
The Royal Society of Edinburgh (RSE), Scotland’s National Academy, and the Young Academy of Scotland (YAS) welcome the opportunity to respond to the Scottish Government’s consultation on the development of a Health and Social Care Strategy. We are well placed to offer supporting evidence to this consultation with our varied expertise in health and social care. Our recent working group included experts in geriatric medicine, end-of-life care, the built environment and wellbeing, and digital healthcare. The comments from the working group have informed the below response.
The RSE was pleased to see the accessibility of the questions within this consultation, and we were glad to see that it was aimed toward people who use health and social care services. We believe that a self-directed approach to care and support is vital. The person should always be in control of their health and care planning and have a voice in the decision-making process when government policy directly impacts their lives. Therefore, we have only answered those questions that are suitable for an answer from an organisation, and we have included a summary of broader points relevant to the consultation.
With the development of a National Care Service, now is a critical time to consider a more holistic approach to social care. A cultural change can help drive this approach, with a fresh perspective on how we view our ageing population, valuing what older people can contribute to society and encouraging their participation in meaningful ways.
We need more collaboration between our health and social care services, with a clear line of accountability. Coordination and collaboration will improve outcomes and ensure more effective and efficient working across the public and third sectors.
Consideration must be given to addressing the lack of access to specialist mental health services for people over 65. Research from Support in Mind Scotland estimated that people experience a 75% reduction in access to community psychiatric nurse services when they reach retirement age.
Design guidance might also be considered to ensure integrated and socially supportive environments in new developments that are built-in by design to encourage more accessible neighbourly/neighbourhood connections for older and more vulnerable people.
We believe there is a need to collect more data at a local level to understand what services are required locally and where there are gaps in services.
Before any changes can be implemented, it is essential to address the current health and social care crisis that exists in Scotland. There are currently many people on the waiting list for social care, with 43% of people found to need substantial or critical care waiting more than six weeks to access services.
Anticipatory care planning should be done proactively and be person-centred rather than focusing on the specific timing of an individual’s death. There is a need for more openness when talking about the ageing process and expectations of death in society so that service users and their families are more willing to discuss their preferences in palliative care.
We would like to see a cultural emphasis on the goal of care, one that promotes independence and, where possible, helps people to move back into their own homes.